maternal infant exam 1

approximately how many women die each year in the US as a result of pregnancy or delivery complications?

700

the US is one of how many countries in which maternal mortality rates have been on the rise in recent years?

8

what are the leading causes of maternal mortality?

severe bleeding, infection/sepsis, cardiovascular conditions, blood pressure disorders, substance use/mental health

t/f: most maternal mortalities are preventable

true

what is the definition of infant mortality?

the death of an infant before his or her first birthday

how many infants died in the US in 2020?

20,000

what were the five leading causes of infant death in 2020?

maternal pregnancy complications, birth defects, preterm birth, SIDS, injuries

the US is ranked what out of 38 in infant mortality rates compared to similarly developed countries?

33

what determines an individual’s sex?

chromosomes, hormones, and reproductive organs

what is the definition of identity?

the internal perception of one’s gender

what is the definition of attraction?

sexual and romantic feelings

how much more likely are black women likely to die in childbirth?

3-4

what socioeconomic factors are rooted in systemic racism and negatively impact reproductive healthcare of black women?

access to prenatal care, insurance coverage, education, income, and quality of hospital care

what are negative impacts of systemic racism and provider bias?

pain isn’t taken seriously, the patient is ignored, and they may experience physical/verbal abuse

what is the definition of reproductive justice?

the human right to bodily autonomy as well as the freedom to make one’s own decisions regarding sexuality, gender, relationships, having children, and raising children in safe and equitable communities

what regulates the reproductive cycle?

sex hormones

what cycles compose the reproductive cycle?

ovarian cycle and the menstrual (uterine/endometrial) cycle

the reproductive cycle ends in one of what two possibilities?

pregnancy or menstruation

gonadotropin releasing hormone stimulates the release of which hormones?

follicular stimulating hormone (FSH) and luteinizing hormone (LH)

what hormones cause the endometrium to thicken and prepare to support a pregnancy?

estrogen and progesterone

what do maturing follicles release?

estrogen

in which phase does the follicle degenerate into corpus luteum after ovulation and egg is released?

luteal phase

what releases progesterone?

the corpus luteum

what are the phases of the ovarian cycle?

follicular phase, ovulation, luteal phase

what is the definition of contraception?

a method or device used to prevent pregnancy that works to block fertilization or implantation

t/f: there is a “best” form of contraception

false

hormonal contraception is centered around what?

estrogen and progestin

what is the mechanism of action for hormonal contraception?

thickens cervical mucus, thins the uterine lining, and prevents ovulation

what are the advantages of hormonal contraception methods?

no effect on future fertility, relieves PMS, lighter periods, can be used to treat PCOS, and reduces acne

what are the disadvantages of hormonal contraception methods?

need a prescription, not effective against STIs

what are side effects of hormonal contraception methods?

nausea, breast tenderness, mood swings, weight gain, headaches

what is the main adverse effect of hormonal contraception methods?

blood clots

what are contraindications of hormonal contraception methods?

hypertension, being a smoker over 35, history of DVT/PE/stroke

in terms of contraception, what is a ring and how does it work?

a silicone based flexible ring that is placed in the vagina for three weeks and is removed during the fourth week, releasing combined hormones slowly and locally

in terms of contraception, what is a patch and how does it work?

a patch is placed on the arm, back, buttocks, or abdomen for three weeks and left off for the fourth week, getting absorbed by fat and circulated systemically

in terms of contraception, what is the pill and how does it work?

a progestin only pill that needs to be taken at the same time every day

what is a combination pill for contraception?

21 combined hormone containing pills and 7 placebo pills that need to be taken at the same time daily

in terms of emergency contraception, what is an implant?

a hormone containing flexible rod requiring medical insertion/removal placed via a small incision that lasts up to 3 years

in terms of contraception, what is an intrauterine device?

long term pregnancy prevention

what are examples of barrier methods of contraception?

female condoms, condoms, diaphragm, cervical cap, cervical sponge

what are surgical methods of contraception?

tubal ligation and vasectomy

what are natural methods of contraception?

calendar, cervical secretions, thermal, withdrawal, abstinence

what is the definition of gestational age?

the age of the pregnancy, beginning with the first day of the last menstrual period

what is the definition of developmental age?

the age of the fetus, starting with the date of conception

what are the three developmental stages of a fetus?

pre-embryonic, embryonic, and fetal

when does the pre-embryonic stage occur?

weeks 0-1 of pregnancy

when does the embryonic stage occur?

weeks 2-8 of pregnancy

when does the fetal stage occur?

weeks 9-38 of pregnancy

what occurs during the pre-embryonic stage of development?

implantation

what occurs during the embryonic stage of development?

organogenesis

what occurs during the fetal stage of development?

rapid growth/development

what key milestone occurs in weeks 5-6 of pregnancy?

fetal heartbeat becomes detectable

what key milestone occurs in week 8 of pregnancy?

organogenesis complete

what key milestone occurs in week 16 of pregnancy?

quickening

what key milestones occur in week 24 of pregnancy?

viability, surfactant

what are the three key roles of the placenta in pregnancy?

circulation, protection, and hormone production

how does the placenta promote circulation to the fetus?

delivers oxygen/nutrients from the pregnant person’s bloodstream into the fetus and removes carbon dioxide and cellular waste

how does the placenta protect the fetus?

transfers the gestational parent’s immunoglobulins that will provide passive immunity to the fetus

how does the placenta impact hormone production?

serves as a temporary endocrine gland

what is the definition of oligohydramnios?

too little amniotic fluid in the amniotic sac

what is the definition of polyhydramnios?

too much fluid in the amniotic sac

what is the vasculature of the umbilical cord?

one large vein and two smaller arteries

what is wharton jelly?

a gelatinous substance surrounding the umbilical vessels which helps the cord slide back and forth and preventing compression of the cord

what is the function of human chorionic gonadotropin (hCG)?

signals corpus luteum to continue producing estrogen and progesterone, which is eventually taken over by placenta

what is the function of progesterone?

facilitates implantation, breast development, metabolism, and decreases uterine contractility

what is the function of estrogen?

facilitates implantation, breast development, uterine/placental growth and blood flow, and increased uterine contractility

what is the function of human chorionic somatomammotropin (hCS0 or human placental lactogen (hPL)?

stimulates lactation and increases metabolism and insulin resistance

what is the function of relaxin?

facilitates implantation, softens the cervix for delivery, relaxes pelvic joints, and increases blood circulation

what are the components of family planning?

the decision to have children, the decision of when to have children, the ability to raise children in a safe environment, and planning before contraception

what are the two key types of unintended pregnancies?

the pregnant person never wanted to be pregnant (unwanted) or they didn’t want to be pregnant this early or at this time (mistimed)

what are the options for unintended pregnancies?

abortion/termination, carry to term and parent, carry to term and give up for adoption

what is the definition of an abortion?

termination of a pregnancy

what is the definition of induced abortion?

termination of a pregnancy through an intervention guided or performed by a healthcare provider

what is the definition of spontaneous abortion?

loss of a pregnancy before the 24th week of pregnancy (miscarriage)

when did abortion initially become illegal in the US?

between 1860 and 1880

when did Roe v Wade federally protect a person’s right to an abortion?

1973

when did Dobbs v Jackson Women’s Health Organization leave the legality of abortions up to the states?

2022

how many abortions were performed in the US in 2023?

just over 1 million

what percentages of abortions performed in the US in 2023 were “abortion by pill”?

63%

what ratio of people capable of pregnancy receive abortions before the age of 45?

1 in 4

who needs jucicial bypass to receive an abortion?

minors

what are complications to outpatient abortion care?

gestational age, bleeding disorders, BMI, previous OB complications, poorly controlled chronic conditions (HTN, DM, SCD), and untreated psychiatric illness

abortion by pill is done using what two medications?

mifepristone and misoprostol

what is the first pill offered in medication abortion?

mifepristone

what are contraindications for mifepristone?

adrenal insufficiency, bleeding disorders, and long term steroid use

what are possible side effects of mifepristone?

nausea/vomiting, abdominal cramps, and potential spotting

what are possible side effects of misoprostol?

nausea, diarrhea, chills, rigors, and fever

up until what gestational age are patients eligible for medication abortion?

10.0 weeks, but some facilities offer up until 11.6 weeks

what is the advantage of a medication abortion compared to a procedural abortion?

less invasive

what medications should a patient take prior to a medication abortion?

anti emetics and NSAIDs 30 minutes before

what can a patient expect after receiving a medication abortion?

bleeding can be intense but is short lived, contractions until pregnancy is passed, and patients may see the pregnancy when it is passed

following a medication abortion, clots should not be larger than what?

a lemon

how much blood following a medication abortion warrants concern?

2 fully saturated pads in an hour for two hours

how long after a medication abortion should the patient follow up with the provider?

7-14 days

what is a manual vacuum aspiration (MVA) procedural abortion?

uses handheld suction to remove the pregnancy

at what gestational age can a manual vacuum aspiration be performed?

5-12 weeks

what is a dilation and evacuation (D+E) procedural abortion?

the cervix is gently opened and the uterine lining is scraped with all tissue removed

at what gestational age can a dilation and evacuation be performed?

13-16 weeks

how long can a dilation and evacuation take?

two days; dilators placed overnight and uterine evacuation the next day

what are possible complications of procedural abortions?

bleeding, infection, damage to the uterus, incomplete abortion